Provider Demographics
NPI:1497772370
Name:MOYES PHARMACY INC
Entity Type:Organization
Organization Name:MOYES PHARMACY INC
Other - Org Name:MOYES PHARMACY HAMPTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LOREN
Authorized Official - Middle Name:B
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:770-474-7693
Mailing Address - Street 1:34 E MAIN ST S
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:GA
Mailing Address - Zip Code:30228-2930
Mailing Address - Country:US
Mailing Address - Phone:770-946-5172
Mailing Address - Fax:
Practice Address - Street 1:34 E MAIN ST S
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:GA
Practice Address - Zip Code:30228-2930
Practice Address - Country:US
Practice Address - Phone:770-946-5172
Practice Address - Fax:770-946-5079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA6749333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1130842OtherOTHER ID NUMBER-COMMERCIAL NUMBER
GA000337796AMedicaid
1130842OtherOTHER ID NUMBER-COMMERCIAL NUMBER